ethics in peadiatrics

1. ETHICAL AND CULTURAL ISSUES
IN PEDIATRIC NURSING
PRESENTED BY: Ms. SUKHRAJ KAUR
LECTURER (M.Sc. PEDIATRICS)
ASHOKA INSTITUTE OF NURSING, PATIALA

2. INTRODUCTION
• The term ‘ethic’ comes from the Greek word:
ethikos which means ‘moral, character’
• The branch of philosophy concerned with the
distinction between right and wrong based on a
body of knowledge, not based only on
opinions.

3. Ethics are involved and/or influence by:

4. LAWS

5. RELIGION

6. SCIENTIFIC STUDIES

7. PHILOSOPHY

8. MORAL

9. PRINCIPLES OF MEDICAL ETHICS
Ethical principles are general statements about
what types of actions are right or wrong.
Including the principles of Autonomy,
Beneficence, Non-maleficience and Justice.

10. conti…
A physician shall, in the provision of appropriate
patient care, except in emergencies, be free to
choose whom to serve, with whom to associate,
and the environment in which to provide
medical care.

11. conti…
A physician shall recognize a responsibility to
participate in activities contributing to the
improvement of the community and the
betterment of public health.

12. conti…
A physician shall support access to medical care
for all people.

13. conti…
Adopted by the AMA's House of Delegates June
17, 2001

14. conti…
Medical care defined by Courts, Legislatures,
Commissions, Media, Ethics Committees, and
others

15. conti…
No longer does the doctor make decisions alone
nor does the autonomous patient exercise his/her
rights without interference.

16. conti…
Clinical ethics: decisions are more process
oriented than outcome oriented, requiring a
process of consensus building, no matter the
outcome.

17. ETHICAL ISSUES IN PEDIATRICS

18. REFUSE IMMUNIZATIONS
A large number of parents refuse to vaccinate
their children, despite evidence dispelling myths
and supporting immunization.

19. REFUSE SEEK CARE
Parents have the responsibility and authority to
make medical decisions on behalf of their
children. This includes the right to refuse or
discontinue treatments, even those that may be
life-sustaining. However, parental decision-
making should be guided by the best interests of
the child.

20. GENETICTHERAPY
Gene therapy involves making changes to the
body’s set of basic instructions, it raises many
unique ethical concerns

21. WITHHOLD THERAPY VS. WITHDRAWAL OF
TREATMENT
A decision to withdraw or withhold treatment
may seem like giving up. But when physicians,
patients and family members communicate
effectively as a team, it can be very satisfying
and empowering.

22. INFORMED CONSENT
The most important goal of informed consent
is that the patient has an opportunity to be an
informed participant in her health care
decisions.

23. Conti…
Pediatric nurses are trained in child development
health care and diseases of children. They deal
with infants all the way up to adolescent children.
These types of nurses specialize in examining both
the physical and psychosocial well-being of a
child.

24. Conti…
The ethical issues pediatric nurses face can be
quite challenging at times, as they must often
professionally solve conflicts involving a
family’s personal values.

25. COPING SKILLS
• If a child is recently diagnosed with a serious
condition, it can be quite overwhelming for
both the child and family members.

26. Conti…
• A pediatric nurse has the responsibility of
helping both the parents and child learn to
cope with a serious illness.

27. RESTRAINING A CHILD
There are certain procedures that require
pediatric nurses to restrain a child. In some
situations it’s absolutely necessary in order to
protect their safety

28. Conti…
• For example, if a child is in need of stitches
but refuses to hold still, the child would need
to be retrained for the procedure.

29. REFUSING TREATMENT
• The parent ultimately has the right to refuse
treatment for their child, as children are
minors.

30. Conti…
• Therefore, it can be quite challenging for a
nurse to have to pull a child from life support
or not give a child certain treatments that may
help them recover, when the nurse feels that
it’s ethically right to do so.

31. RELIGIOUS BELIEFS
• Despite a pediatric nurse’s spiritual or religious
beliefs, she must comply with the family’s
beliefs, not allowing her own feelings to
personally get in the way.

32. ACCEPTING REALITY
• Losing a child can be the most difficult thing a
family will ever go through. In some cases,
parents refuse to accept this, and want to
perform more treatments.

33. Conti…
• However, a pediatric nurse must help family
members understand when there is nothing
else that can be done in order to save the child.

34. ISSUES IN PEDIATRIC NURSING
• Pediatric nurses are professional registered
nurses who often assist in the care and
treatment of young children or babies. The
young children and babies are sick, and some
are terminally ill and dying.
• A pediatric nurse has to remain ethical and
keep the best interest of the patient in mind at
all time to avoid legal issues.

35. HEALTH ISSUES
• A pediatric nurse is always put in dangerous
situations, which is an issue for the nurse.
• Pediatric nurses are exposed to health hazards,
such as infectious disease because of the places
he works, and the direct contact the pediatric
nurse has with patients.

36. Conti…
• Pediatric nurses run the risk of being injured by
sharp object such as needles and blades.
• A pediatric nurse can also face the issues of
musculoskeletal problems and other back pain
problems due to carrying children and babies.

37. PATIENT ADVOCATE
• A pediatric nurse has the duty of remaining an
advocate for the patient. If the patient's activity
after or during treatment changes.

38. Conti…
• A pediatric nurse has the responsibility of
alerting physician of these changes
immediately. If the patient's physician is not on
call or working, then the pediatric nurse has
the responsibility to notify a working physician
who can provide proper care

39. CONFIDENTIALITY
• All information of the patient a pediatric nurse
is caring or treating must remain confidential.
• The pediatric nurse may not share the patient's
condition with anyone outside of the parents, or
authorized family, guardian or friends of the
patient.

40. Conti…
• Violating the patient's privacy is a violation of
the nursing ethics. A pediatric nurse is made to
follow, and a lawsuit can result because of this
violation. Along with a lawsuit, the pediatric
nurse can run the risk of losing his job and
nursing license.

41. PATIENT CONSENT
• Before a pediatric nurse administers treatment,
medication or other forms of health care, the
nurse has the responsibility of informing the
patient and the family caring for the patient of
the treatment.

42. CONTI…
• The patient or the patient's parents must be
fully aware of what is going on.
• In some cases, a patient, parent or guardian
must sign a consent form, depending on the
type of treatment the pediatric nurse is
administering or providing. If the pediatric
nurse does not fully explain the form of health
care, the patient could become ill as a result,
which will bring the issue of a lawsuit for the
health care provider and the pediatric nurse.

43. BEST INTEREST OF PATIENT
• Pediatric nurses must have the ability to treat
and comfort patients who are dying. A legal
issue that can arise with a pediatric nurse is not
honoring the wishes of the patient or the
patient's parents and guardians.

44. CONTI…
• Some pediatric nurses become emotionally
attached to patients, and take matters into their
own hands.
• The pediatric nurse has a legal obligation to
respect the wishes of the patient, and do what
is in the patient's best interest.
• Violating orders can lead to job and license
loss of the pediatric nurse.

45. ETHICAL DILEMMA
• An ethical dilemma is one in which a person
has to choose between two options, both of
which are morally correct but in conflict.

46. CONTI…
• The nurse must make a choice between two
alternatives that are equally unsatisfactory.
They both deal with questions of right and
wrong.
• Such dilemmas may occur as a result of
differences in cultural or religious beliefs.

47. EXAMPLES OF NURSING ETHICAL
DILEMMAS
INAPPROPRIATE MEDICATION ORDERS
• Giving wrong medication dosages or
medication for the wrong illness is unsafe for
patients and may lead to death.
• Nurses can find themselves in an ethical
dilemma when they have to challenge a
medication order written by a physician.

48. UNRESPONSIVE PHYSICIANS
• Nurses often have to call on physicians in
situations beyond their scope of practice such
as medical emergencies.
• The nurse finds herself in an ethical dilemma if
the physician does not respond and her
patient's condition goes from bad to worse.

49. INAPPROPRIATETASKS
• Nurses float from department to department in
the course of their career.
• When a nurse finds herself in an unfamiliar
department and is asked to provide care she is
inadequately trained for, she may have to
refuse to provide care to avoid making the
patient unsafe.

50. LIFETHREATENING PATIENT DECISIONS
• Patients sometimes make decisions that are
unsafe, such as refusing treatment for a baby,
medication or lifesaving procedures.
• The nurse finds herself in an ethical dilemma
because not giving the needed treatment goes
against beneficence and giving it ignores
patient autonomy.

51. SOLVE AN ETHICAL DILEMMA
INSTRUCTIONS
• Consider your own motives and try to detach
them from your decision. If your ethical
dilemma is whether to tell your friend's
husband that she's cheating, your instinct
might be to keep quiet rather than potentially
lose your friendship.
• Take your own feelings out of the equation and
focus on consequences to the involved parties.

52. CONTI…
• Consider your moral code of conduct. If you're
pondering ethical issues, you must have a
strong sense of right and wrong.
• Ask your conscience what the right thing to do
is. See if that makes the dilemma easier to
solve.

53. PEDIATRIC CODE OF ETHICS
• Pediatricians are physicians who specialize in
the care of infants and children. They are
respected and trusted members in the
community.
• The American Medical Association (AMA)
developed a code of medical ethics that the
organization says contains "standards of
conduct that define honorable behavior" for
physicians.

54. PATIENT CARE
• According to the AMA Principles of Medical
Ethics, physicians should be dedicated to
providing competent medical care and take
care to respect patients' dignity and rights.
• They should also be responsible for a patient
who is under their care, and support medical
access for everyone.

55. PATIENT CONFIDENTIALITY
Physicians should respect the rights of their
colleagues and other health professionals, as well
as protect patient confidentiality and privacy.

56. COMMUNITY INVOLVEMENT
The AMA suggests that physicians have a
responsibility to get involved in their community
by participating in activities that improve public
health.

57. RESEARCH
• Physicians are required to study and advance
their medical knowledge.
• They should make relevant medical information
available for patients, other physicians and the
public.

58. THE LAW
• The Principles of Medical Ethics also state that
physicians should respect the law when
providing patient care, but also seek to change
the law if it is in the best interest of the patient

59. CULTURAL ISSUES IN PEDIATRICS
• Cultural beliefs and traditions affect family
members to perceive health & illness. Each
culture has its own beliefs and values and that
is based on generation to generation.

60. SOCIOECONOMICFACTORS
• A higher percentage of low socioeconomic
group children suffer from many health
problems.

61. CONTI…
• Children of lower classes are unlikely to be
immunized properly
• Nurse must enquire about immunization and
provide nutritional information.

62. POVERTY
• Improvised families suffer from poor nutrition.
• Most significant health problem associated
with poverty is high infant mortality rate.

63. CONTI…
• Due to lack of money, people may consult folk
practitioners.
• Inadequate diet leads to nutritional deficiencies
(like anemia) and also growth retardation in
children.
• Poor sanitation and overcrowding leading to
illness.

64. MIGRANT FAMILIES
• Their children mostly suffer from dental caries,
upper respiratory tract infection, tuberculosis
and growth and development delay
• Even if medical care is provided for migrants,
follow- up is difficult.

65. CUSTOMS AND FOLKWAY ON HEALTH
• The more the nurses know about the values,
beliefs and customs and other ethinic groups,
they are better able to meet the needs of these
families.

66. CONTI…
• For example: some culture view chronic illness
or disability as affecting only particular aspects
of child’s life and the whole child is viewed as
normal.

67. CONTI…
• In some cultures, gender may influence a
family’s perception of implications of illness
or disability.
For example: in Arabic and Asian cultures, male
child is having higher esteem.

68. CONTI…
• Different diseases or signs and symptoms of
illness is also influenced by culture
For example: diarrhea is considered as cleaning
of the body that is essential for health
maintenance and illness prevention.

69. FOOD CUSTOMS
• Food customs and symbolism are an integral
part of various cultural, ethical and religious
groups
• Special holidays, ceremonies, birthdays and
deaths are often marked by a special food
items

70. CONTI…
• There are many dietary restrictions in few
cultures causing malnutrition in children
For example: seven- day Adventists vegetarian
diet.

71. BIBLIOGRAPHY
• Bbehraman Richerde. Nelson text book of
pediatrics 16 edition. Harcourt india Pp -5-9,
11-13.
• Parthasarathy A. Text book of pediatrics.
Jaypee publisher. 8th edition. Pp-160
• Marlow R. Dorothy Text book of pediatric
nursing. Elsevier publisher. Sixth edition. Pp-
383-384

72. • Padamja A text book of child health nursing.
Jaypee publishers. 1st edition. Pp – 31- 32
• WEBSITE
• http://www.smilefoundationindia.org/child_rig
hts.htm
• http://en.wikipedia.org/wiki/Category:Children
's_rights_in_India
• JOURNALS
• http://iosrjournals.org/
• Cultural and Ethical Issues Concerning
Research on American Indian Youth